Provider Demographics
NPI:1023396165
Name:KEWALRAMANI, MAYUR (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAYUR
Middle Name:
Last Name:KEWALRAMANI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 AMERICAN LEGION HWY
Mailing Address - Street 2:COMMUNITY FAMILY DENTAL
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-3901
Mailing Address - Country:US
Mailing Address - Phone:617-553-8100
Mailing Address - Fax:
Practice Address - Street 1:644 AMERICAN LEGION HWY
Practice Address - Street 2:COMMUNITY FAMILY DENTAL
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-3901
Practice Address - Country:US
Practice Address - Phone:617-553-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855797122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist